Setting Research Priorities Research Articles

Research priorities relating to communication and swallowing for people with learning disabilities across the lifespan

PurposeThis research priority setting partnership (PSP) aims to collaboratively identify the “top ten” research priorities relating to communication and swallowing for children and adults with learning disabilities, across the lifespan in the UK, using a modified James Lind Alliance approach.Design/methodology/approachA steering group and reference group were established to oversee the PSP. A survey of speech and language therapists (SLTs) resulted in 157 research suggestions. These were further developed into 95 research questions through a multi-stakeholder workshop. Questions were prioritised via an online card-sort activity completed by SLTs, health-care or education professionals and carers. Research questions were analysed thematically. Ten adults with learning disabilities were supported to assign ratings to themes reflecting their prioritisation. The top ten research priorities were identified by combining results from these activities.FindingsThe top ten research priorities related to intervention, outcome measurement and service delivery around communication and dysphagia.Originality/valueTo the best of the authors’ knowledge, this is the first UK-wide research PSP on learning disabilities and speech and language therapy across the lifespan. It uses a novel approach to incorporate the preferences of people with learning disabilities in the prioritisation.

Setting research priorities for management and treatment of hyperhidrosis: the results of the James Lind Alliance Priority Setting Partnership.

SummaryBackgroundHyperhidrosis is a common skin condition characterized by excessive sweating, which can negatively impact on quality of life. It is under‐researched compared with other conditions of similar prevalence.AimTo generate a Top 10 list of research priorities for the treatment and management of hyperhidrosis, with equal input from people with hyperhidrosis and healthcare professionals (HCPs).MethodsA priority setting partnership (PSP) was established and processes from the James Lind Alliance Handbook were followed. An online survey asked participants what questions they would like research to answer. These questions were grouped into ‘indicative questions’, which were ranked in a second survey of 45 indicative questions. The top 23 questions were then taken to a final workshop event attended by key stakeholders, and ranked to generate the Top 10 list of research priorities.ResultsThere were 592 questions submitted by 268 respondents for the first survey. For the second survey, 286 participants ranked the indicative questions in order of priority. At the final workshop, the Top 10 list was generated. The top three priorities were: (i) Are there any safe and effective permanent solutions for hyperhidrosis? (ii) What is the most effective and safe oral treatment (drugs taken by mouth) for hyperhidrosis? and (iii) What are the most effective and safe ways to reduce sweating in particular areas of the body?ConclusionsThere are many unanswered research questions that both people with hyperhidrosis and HCPs would like to see answered. The results from this PSP will help to ensure future research funding can be directed to these areas of priority.

Developing an obesity research agenda with British Pakistani women living in deprived areas with involvement from multisectoral stakeholders: Research priority setting with a seldom heard group.

IntroductionBritish Pakistani women have exceptionally high rates of obesity and yet are seldom heard in a research priority setting concerning weight management. The objectives of this study were (i) to ascertain what multisectoral professionals perceive to be the most pressing unmet obesity needs or topic areas that need more research in relation to Pakistani women living in deprived areas of Bradford and (ii) to determine the top 10 obesity health priorities for this group to develop an obesity research agenda.MethodsA two‐step process was adopted using the following: (i) a survey of a wide range of multisectoral professional stakeholders (n = 159) and (ii) a ranking exercise involving Pakistani women living in deprived areas of Bradford (n = 32) to select and prioritize their top 10 obesity health concerns and unmet needs from a list of 31 statements identified in the survey and previous research. Survey data were analysed using inductive content analysis and themes were identified. Themes were translated into statements to be ranked by Pakistani women. The ranking exercise was conducted by telephone either via voice or video call. Data were analysed using a reverse scoring system.ResultsSurvey responses were grouped into statements reflecting the following three categories: education needs; healthy behaviour barriers and mental well‐being. The highest rankings were given by Pakistani women to statements on mental health and the need for education. The top 10 prioritized statements were developed with members of the public into an obesity research agenda that reflected the target population.ConclusionActively engaging British Pakistani women in setting research priorities provided a unique opportunity to understand the key areas they think are important for future research. The culminating research agenda can be used by researchers to advance the field of obesity research in Pakistani communities, thus producing research outputs that are relevant to and have impact in this population.Patient or Public ContributionParticipants in the ranking exercise collected data. Public contributors were involved in developing the prioritized statements into a research agenda.

A Systematic Framework for Prioritizing Burden of Disease Data Required for Vaccine Development and Implementation: The Case for Group A Streptococcal Diseases.

Vaccine development and implementation decisions need to be guided by accurate and robust burden of disease data. We developed an innovative systematic framework outlining the properties of such data that are needed to advance vaccine development and evaluation, and prioritize research and surveillance activities. We focus on 4 objectives—advocacy, regulatory oversight and licensure, policy and post-licensure evaluation, and post-licensure financing—and identify key stakeholders and specific requirements for burden of disease data aligned with each objective. We apply this framework to group A Streptococcus, a pathogen with an underrecognized global burden, and give specific examples pertinent to 8 clinical endpoints. This dynamic framework can be adapted for any disease with a vaccine in development and can be updated as vaccine candidates progress through clinical trials. This framework will also help with research and innovation priority setting of the Immunization Agenda 2030 (IA2030) and accelerate development of future vaccines.

Setting research priorities to achieve long-term national road safety goals in Iran.

BackgroundRoad traffic crashes (RTCs) and its associated injuries are one of the most important public health problems in the world. In Iran, RTCs rank second in terms of mortality. To address this issue, there is a need for research-based interventions. Prioritizing researches using a variety of approaches and frameworks to determine the most effective interventions is a key nodal point in the RTCs' research policy planning cycle. Thus, this study aims to generate and prioritize research questions in the field of RTCs in Iran.MethodsBy adapting the Child Health and Nutrition Research Initiative (CHNRI) method, this study engaged 25 prominent Iranian academic leaders having role in setting Iran’s long-term road safety goals, a group of research funders, and policymakers. The experts' proposed research questions were independently scored on a set of criteria: feasibility, impact on health, impact on the economy, capacity building, and equity. Following the prioritization of Research Questions (RQs), they were all classified using the 5 Pillar frameworks.ResultsIn total, 145 Research Questions were systematically scored by experts against five criteria. Iran's top 20 road traffic safety priorities were established. The RQs related to “road safety management” and “road and infrastructure” achieved a high frequency.ConclusionsThe top 20 research questions in the area of RTCs in Iran were determined by experts. The majority of these RQs were related to “road safety management”. The results of this study may contribute to the optimal use of resources in achieving long-term goals in the prevention and control of road traffic crashes and its related injuries. Considering these RQs as research investment options will improve the current status of Road Traffic Injuries (RTIs) at a national level and further advance toward compliance with international goals. If these research priorities are addressed, and their findings are implemented, we can anticipate a significant reduction in the number of crashes, injuries, and deaths.

Overcoming structural barriers to sharing power with communities in global health research priority-setting: Lessons from the Participation for Local Action project in Karnataka, India

ABSTRACT Community engagement is gaining prominence in global health research. But communities rarely have a say in the agendas or conduct of the very health research projects that aim to help them. This paper provides new evidence on how to share power in priority-setting in ways that seek to overcome structural constraints created by the funding environment. The five strategies were identified through case study research on the Participation for Local Action project in Karnataka, India. That project was carried out by researchers in partnership with the Zilla Budakattu Girijana Abhivrudhhi Sangha, an indigenous community development organisation representing the Solega people. The paper describes each identified strategy for sharing power in priority-setting, followed by a report of the pitfalls and challenges that arose when implementing it. Thus, the study also demonstrates that even where actions and strategies are used to address power imbalances, pitfalls will arise that need to be navigated. Given those challenges, considerations to reflect upon before employing the identified strategies are suggested. Ultimately, the paper aims to communicate strategies for sharing power during and after priority-setting and lessons on how to implement them effectively that can be used by global health researchers in the current funding environment.

Medical Education Research Priorities for Master’s Students in Sudan: A Qualitative Study

Background: Believing research prioritization can increase the research value and augment advances in the scientific base of any profession, this study aimed to identify research priorities relevant for medical education in Sudan.
 Methods: The study was designed to capture a qualitative exploration of multiple stakeholders’ opinions. Data were collected from two stakeholder groups: experts and students of medical education in Sudan. Semi-structured individual interviews and focus groups from 10 experts and 41 learners were incorporated. The categories and subcategories, derived from experts’ data inductively through constant comparison, enhanced the development of a coding framework. This framework was used deductively to analyze the beliefs and opinions of the learners leading to a list that exemplifies priorities for medical education research.
 Results: A set of seven principal and three minor themes were identified, the principal themes were: Curriculum Content, Design, and Delivery; Faculty Development; Assessment Methods; Research; Accreditation, Evaluation, and Quality; Professionalism; and Student Selection and Support. Four themes were identified to justify participants’ selections: Quality education and patient care; Accreditation of schools; Curricula contextualization; and Documentation of success stories.
 Conclusion: This instrumental research fulfilled its aim to mount a set of medical education research priorities grounded in collected perceptions with optimal stakeholder engagement. Importantly, there were many more similarities than differences between these findings and those from other countries which suggests that some topics are relevant across the international arena and one may propose the commencements of an international medical education agenda.

Priority Setting for Collaborative Health Systems Research in India: A Method and the Way Forward

A comprehensive and collaborative knowledge translation and decision-making approach can help reduce the longstanding barriers to using research in policy and practice. Regular interaction between researchers and decision-makers increases the likelihood of using research knowledge. This interaction continuing over the entire research cycle is critical for developing research directions and potential use of the research outputs that benefit the health system. The India Health Systems Collaborative and ACCESS Health International have conducted a rigorous exercise to arrive at the priority research topics. A consensus-based method customised to the existing need was created, adapting from the Child Health and Nutrition Research Initiative (CHNRI) method for research priority setting. In this method, conducting literature reviews, key informant interviews and survey-based stakeholder consultations are critical steps for identifying policy-relevant research topics that demand utmost attention in the Indian setting. This article documents the processes followed to develop a preliminary list of core research priorities requiring urgent attention to facilitate policy development. Additionally, the article is about the essential and immediate next steps and the critical actions taken to undertake collaborative research on the identified research topics. The special issue of the Journal for Health Management dedicated to strengthening the Indian health system sets the foundation for promoting collaborative research, its dissemination for broader use by researchers and ensuing policy dialogues.

Research priority setting with parents of students with learning exceptionalities and disabilities

With an increasing focus on knowledge mobilisation, there is a concomitant shift in how stakeholders, such as parents, ought to be engaged in the research process. The purpose of this study was to explore the research priorities of parents of Kindergarten to Grade 12 students with learning exceptionalities and disabilities in British Columbia, Canada. A cross‐sectional survey design was employed. A convenience sample of 130 parents completed the survey. From a list of pre‐selected variables, parents identified time to initial designation, high school graduation, and home‐schooling/independent schooling as the three most important research priorities, with learning disabilities, autism spectrum disorder, and moderate behaviour support/mental illness as the three most important designations. In an open‐ended response, parents recommended further areas for inquiry, including the effectiveness of inclusive education and school exclusion. Research priority setting can help create research agendas that align with the needs and interests of stakeholders.

Using Social Media to Engage Knowledge Users in Health Research Priority Setting: Scoping Review.

BackgroundThe need to include individuals with lived experience (ie, patients, family members, caregivers, researchers, and clinicians) in health research priority setting is becoming increasingly recognized. Social media–based methods represent a means to elicit and prioritize the research interests of such individuals, but there remains sparse methodological guidance on how best to conduct these social media efforts and assess their effectiveness.ObjectiveThis review aims to identify social media strategies that enhance participation in priority-setting research, collate metrics assessing the effectiveness of social media campaigns, and summarize the benefits and limitations of social media–based research approaches, as well as recommendations for prospective campaigns.MethodsWe searched PubMed, Embase, Cochrane Library, Scopus, and Web of Science from database inception until September 2021. Two reviewers independently screened all titles and abstracts, as well as full texts for studies that implemented and evaluated social media strategies aimed at engaging knowledge users in research priority setting. We subsequently conducted a thematic analysis to aggregate study data by related codes and themes.ResultsA total of 23 papers reporting on 22 unique studies were included. These studies used Facebook, Twitter, Reddit, websites, video-calling platforms, emails, blogs, e-newsletters, and web-based forums to engage with health research stakeholders. Priority-setting engagement strategies included paid platform–based advertisements, email-embedded survey links, and question-and-answer forums. Dissemination techniques for priority-setting surveys included snowball sampling and the circulation of participation opportunities via internal members’ and external organizations’ social media platforms. Social media campaign effectiveness was directly assessed as number of clicks and impressions on posts, frequency of viewed posts, volume of comments and replies, number of times individuals searched for a campaign page, and number of times a hashtag was used. Campaign effectiveness was indirectly assessed as numbers of priority-setting survey responses and visits to external survey administration sites. Recommendations to enhance engagement included the use of social media group moderators, opportunities for peer-to-peer interaction, and the establishment of a consistent tone and brand.ConclusionsSocial media may increase the speed and reach of priority-setting participation opportunities leading to the development of research agendas informed by patients, family caregivers, clinicians, and researchers. Perceived limitations of the approach include underrepresentation of certain demographic groups and addressing such limitations will enhance the inclusion of diverse research priority opinions in future research agendas.

How is inclusiveness in health systems research priority-setting affected when community organizations lead the process?

Community engagement is gaining prominence in health research. But communities rarely have a say in the agendas or conduct of the very health research projects that aim to help them. One way thought to achieve greater inclusion for communities throughout health research projects, including during priority-setting, is for researchers to partner with community organizations (COs). This paper provides initial empirical evidence as to the complexities such partnerships bring to priority-setting practice. Case study research was undertaken on a three-stage CO-led priority-setting process for health systems research. The CO was the Zilla Budakattu Girijana Abhivrudhhi Sangha, a district-level community development organization representing the Soliga people in Karnataka, India. Data on the priority-setting process were collected in 2018 and 2019 through in-depth interviews with researchers, Sangha leaders and field investigators from the Soliga community who collected data as part of the priority-setting process. Direct observation and document collection were also performed, and data from all three sources were thematically analysed. The case study demonstrates that, when COs lead health research priority-setting, their strengths and weaknesses in terms of representation and voice will affect inclusion at each stage of the priority-setting process. CO strengths can deepen inclusion by the CO and its wider community. CO weaknesses can create limitations for inclusion if not mitigated, exacerbating or reinforcing the very hierarchies that impede the achievement of improved health outcomes, e.g. exclusion of women in decision-making processes related to their health. Based on these findings, recommendations are made to support the achievement of inclusive CO-led health research priority-setting processes.

Research Priority Setting: The Current Landscape of Neuroscience Nursing Research.

BACKGROUND: The American Association of Neuroscience Nurses established a 6-member Research Agenda Task Force in 2019 to identify neuroscience nursing research priorities to lead the field for the next 3 to 5 years. An early step in the process was a literature search to gain an understanding of the current landscape of neuroscience nursing research. METHODS: A search strategy was developed to locate relevant neuroscience nursing research. An experienced medical librarian performed a comprehensive systematic search of multiple databases. Task force members then further refined the search. A separate search was conducted to locate published research by 21 known neuroscience nurse researchers. RESULTS: An initial search located 466 qualitative articles and 1243 quantitative articles, with a further 655 articles published by known neuroscience nurse researchers. All 2364 citations were reviewed by task force members of the working in pairs to screen titles and abstracts for relevance. Nine categories of neuroscience nursing research were identified: quality of life, nursing practice, biomarkers, health promotion, professional development, technology, nursing care outcomes, assessment, and caregivers. Most of the research used descriptive methods, including both quantitative and qualitative methods of inquiry, providing a foundation for more rigorous investigation and interventional research. Research following stroke and the critical care setting were most prevalent. DISCUSSION: New and emerging trends in neuroscience nursing research include the use of technology, biomarkers, lay caregivers, strategies, and tools, including measure development for neurological assessment, and the evaluation of nursing practice including the practice environment and advanced practice nurse providers. Gaps were also evident. CONCLUSION: There is a significant need to expand neuroscience nursing in areas of emerging trends and to use rigorous methods to evaluate nursing practice effects on patient outcomes. The results of this search were used to revise the neuroscience nursing priorities last determined in 2011.

A Delphi Study to Establish Research Priorities for Neuroscience Nursing.

BACKGROUND: Establishing research priorities is essential not only to support evidence-based nursing practice but also to direct research agendas for nursing organizations such as the American Association of Neuroscience Nursing. METHODS: A 6-member Research Agenda Task Force selected potential research priorities based on a literature search of neuroscience nursing research. Using a 2-round, modified Delphi methodology, electronic surveys were distributed to 53 neuroscience nursing experts to gain consensus on the research priorities for neuroscience nursing. Survey data included demographics, agreement with selected gaps in neuroscience nursing research, and impact of selected neuroscience nursing research topics on the field. RESULTS: Twenty-six of 53 experts (49% response rate) participated in round 1, and 30 of 53 experts (57% response rate) participated in round 2. In round 1, the Research Agenda Task Force members revised the list of gaps in neuroscience nursing research to include only the top 39 ranked topics with greater than or equal to 73% agreement, created a new category "Professional Practice Issues," and added 1 additional topic. In round 2, 14 topics were ranked greater than or equal to 70% impactful and identified as the top neuroscience nursing research priorities. CONCLUSION: The results of this study served as an effort for creating research priorities and enhancing research collaboration that focuses on neuroscience nursing. Focusing on gaps in the literature and setting research priorities can ultimately improve patient outcomes. Neuroscience nursing research priorities can be used to inform, guide, and aid nurse scientists, educators, and providers, and to inform agencies that provide research and program funding.

Adolescent mental health research in Tanzania: a study protocol for a priority setting exercise and the development of an interinstitutional capacity strengthening programme

IntroductionPoor adolescent mental health is a barrier to achieving several sustainable development goals in Tanzania, where adolescent mental health infrastructure is weak. This is compounded by a lack of community...

Patients' experiences of cannulation of arteriovenous access for haemodialysis: A qualitative systematic review.

Cannulation is an essential part of haemodialysis with arteriovenous access. Patients' experiences of cannulation for haemodialysis are problematic but poorly understood. This review aims to synthesise findings related to patients' experiences of cannulation for haemodialysis from qualitative studies, providing a fuller description of this phenomenon. Eligibility criteria defined the inclusion of studies with a population of patients with end-stage kidney disease on haemodialysis. The phenomena of interest was findings related to patients' experiences of cannulation for haemodialysis and the context was both in-centre and home haemodialysis. MedLine, CINAHL, EMBASE, EMCARE, BNI, PsycInfo and PubMed were last searched between 20/05/2019 and 23/05/2019. The quality of studies was assessed using the using Joanna Briggs Critical Appraisal Checklist for Qualitative Research. Meta-aggregation was used to synthesise findings and CERQual to assess the strength of accumulated findings. This review included 26 studies. The subject of included studies covered cannulation, pain, experiences of vascular access, experiences of haemodialysis and a research priority setting exercise. From these studies, three themes were meta-aggregated: (1) Cannulation for haemodialysis is an unpleasant, abnormal and unique procedure associated with pain, abnormal appearance, vulnerability and dependency. (2) The necessity of cannulation for haemodialysis emphasises the unpleasantness of the procedure. Success had multiple meanings for patients and patients worry about whether the needle insertion will be successful. (3) Patients survive unpleasant, necessary and repetitive cannulation by learning to tolerate cannulation and exerting control over the procedure. Feeling safe can help them tolerate cannulation better and the cannulator can invoke feeling safe. However, some patients still avoid cannulation, due to its unpleasantness. Cannulation is a pervasive procedure that impacts on patients' experiences of haemodialysis. This review illuminates further patients' experiences of cannulation for haemodialysis, indicating how improvements can be made to cannulation. PROSPERO (CRD42019134583).

Who published what on Somali health issues?

In this editorial we attempt to define additional rationales for SHAJ, the Somali Health Action Journal, further to those presented in our inaugural editorial. We recognize the health information divide as one of the three health gaps characterizing the global health inequality landscape. The SHAJ venture emerged from a joint Somali-Swedish initiative to revive a former collaborative research programme also recognizing the need for a Somali-based platform for research communication. The members of the SHAJ Editorial team decided to join forces in designing and carrying out an empirical bibliometric study to assess the state of the art of the published literature on Somali health issues over a 75-year period covering major societal development eras in Somali academic history. This editorial is basically presented in the form of a report from this study, concluding with a statement on the policy implications for SHAJ and Somali based research for health. The study raises concerns about the scarcity of research publications on Somali public health issues. This points to the need for research capacity strengthening in general and with special attention to the important role of the newly established Somali universities. We note a lack of balance regarding the topics and public health relevance of published papers in relation to the burden of prevailing health problems which calls for efforts to set research priorities in tune with the broad needs of the communities. Another observation is that the papers reviewed indicate a heavy dependence of the research agenda on external organisations and funders, which calls for active attention to research ownership issues in terms of Somali leadership and authorship. There is a lack of dissemination channels for Somali based health research and limited possibilities for young Somali scientists to publish their studies. As a Somali-owned journal, we envisage that SHAJ can play a catalytic role in the promotion and dissemination of "Essential Somali Health Research".

Exploring the Research Priorities for Occupational Therapy in India: A Descriptive Review.

BackgroundOccupational therapists are considered an important workforce for the rehabilitation of persons with disabilities globally. However, in India, the profession is just beginning to gain recognition within the national and state-level systems for health care. One of the reasons for this could be the paucity of specific research related to the development of occupational therapy (OT) and its benefits to the health systems. Therefore, it is of immense public health importance to explore the priorities and gaps in OT research in India. A vast majority of the OT research in India is promoted and disseminated through the All-India Occupational Therapists Association (AIOTA) and its annual national conference (ANC).ObjectivesThe objective of this study is to descriptively review the conference abstracts of the AIOTA ANC published in the Indian Journal of OT (IJOT), an official publication of the AIOTA, from 2017 to 2021.Study DesignThe study design was a descriptive, nonsystematic review.MethodsReview of the abstracts selected for the AIOTA ANC published in the IJOT from 2017 to 2021. A data extraction form was developed and used to synthesize data related to the clinical and demographic characteristics of OT research in India.ResultsThe search yielded 218 abstracts. State-level trends indicated that close to 85% of the research submissions were from four states and no submissions from the northeastern states until 2020. Nearly 60% of the abstracts were clinical research with OT interventions. About 40% of these research abstracts were related to pediatrics, followed by neurology (17%), musculoskeletal (15%), mental health (10%), and ergonomics and assistive technology (8%). There were 1%-2% of research abstracts submitted related to coronavirus disease-2019 (COVID-19) and geriatrics. About 85% of the research abstracts were related to impairment (39%), activity limitation (26%), and social participation (22%).ConclusionThis review highlights the need for diversifying the research in OT in India. This is particularly important in relation to expanding from selected states to pan-India research and development, especially in the northeastern states. Furthermore, the focus of OT research must move beyond impairments and approach disability from the biopsychosocial perspective. It is also very important to diversify the research in OT to areas that are of public health importance such as COVID-19, geriatrics, noncommunicable diseases, and rehabilitation in health systems. Priority setting for research in OT in India is an important implication of this review.

Research priorities to improve the health of children and adults with dysphagia: a National Institute of Health Research and Royal College of Speech and Language Therapists research priority setting partnership

ObjectiveTo conduct the first UK-wide research priority setting project informing researchers and funders of critical knowledge gaps requiring investigation to improve the health and well-being of patients with eating, drinking...

Patient engagement in the SPOR Evidence Alliance: Reflection and learnings

The Evidence Alliance (EA) is a Canada-wide multi-stakeholder organization providing national-level support in knowledge synthesis, clinical practice guidelines development, and knowledge translation. With a mandate to deliver the best available evidence to inform health policy and improve patient care, the EA involves patients and their caregivers in its governance, research priority setting and conduct, and capacity building. To reflect on the experiences of patient involvement in its first three years, the organization conducted a self-study with 17 actively involved patient partners. They answered the Patient Engagement in Research Scale 22-item short form (PEIRS-22) and open-ended questions. Of the 15 respondents, 12 were women with a mean age of 62.6 years (SD 10.1). The mean PEIRS-22 score was 82.1 (SD 15.9), indicating perceived meaningful engagement. Analysis of the free-text answers identified three themes: ( i) communication: successes, changes, and improvements; ( ii) a respectful and welcoming environment; and ( iii) opportunities to learn and contribute. Patient partners noted the EA made genuine efforts to welcome them and value their contributions. They also identified a need for the organization to increase patient partner diversity. This self-study was perceived as rewarding as it provided a foundation for further growth in patient involvement within the organization.

Patient Priorities for Pulmonary Rehabilitation Research

Patient engagement in setting research priorities may guide a clinical research program to ensure relevance to the target population. In this cross-sectional survey, people who had participated in pulmonary rehabilitation were asked to prioritize research topics relevant to this area. Twenty-four previously identified topics were presented under 7 themes. Respondents were asked to select all themes and topics of importance, and then to rank them in order of importance. Ninety-six responses were included. The top ranked topic in the top ranked theme was creating an after-maintenance program to keep patients on track.